On last night’s Q&A, feminist campaigner Germaine Greer suggested a comparison between practices of female genital mutilation (FGM) in Africa and female genital cosmetic surgery (FGCS) in Western nations.

To make her point, Greer cited labiaplasty (where the labia minora are surgically reduced) and clitoral reduction of newborn girls in the medical management of “ambiguous genitalia”.

Greer is right: one central reason in the West for surgical intervention in babies’ genitals is to ensure gender conformity of intersexed genitalia.

Greer tackled the difficult issue of female genital mutilation in a very un-Greer-like fashion — with tact and sensitivity, rather than her traditional style of outrageous polemical provocation.

The audience seemed perplexed. Was Australia’s mother of second wave feminism advocating cultural relativism? Was she somehow condoning female genital mutilation by suggesting such a comparison?

Yet Greer was voicing what feminist academics had already been saying in the (admittedly tiny) body of literature on Western practices of cosmetic labiaplasty.

Of course there are differences between female genital mutilation and female genital cosmetic surgery, the most striking of which is the conditions under which they are performed. Common to FGM is the use of non-sterile instruments in unhygienic conditions, whereas FGCS is typically “medicalised”, carried out in professional surgical environments like plastic/cosmetic surgeons’ clinics.

Yet FGM and FGCS may not be as dissimilar as we might imagine.

People in the West who have never been exposed to genital mutilation in their own cultures tend to think of genital cosmetic surgery as a singular thing – that is, as clitoral excision and the sewing together of the lips of the vulva to leave a small hole for menstruation and urinary flow, which is then painfully reopened for childbirth and stitched back together afterwards.

In fact, FGM, as it is defined by the World Health Organization, covers a range of interventions, from infibulation (the sewing up of the lips), removal of the clitoris and labia minora and/or majora, removal of the labia minora only, and removal of the clitoral hood to piercing, pricking, scraping, incising and cauterisation.

Just like FGM, FGCS is also a variety of procedures, from vaginal tightening and plumping up or syphoning fat from the outer labial lips, to cutting off the inner lips.

In Britain, the United States and Australia, FGM is outlawed but FGCS is not.

As far as I know, infibulation is not performed by Western cosmetic or plastic surgeons, however, they do perform clitoral hood reduction and labial excision.

I even read one case study in the literature where a clitoridectomy was performed on 33-year-old heterosexual woman in the United Kingdom (who, the surgeons said, was not from a culture that conducted FGM) at the woman’s behest.

Q&A: Greer echoed what feminist academics have been saying about Western practices of cosmetic labiaplasty.AAP

You might think consent is important in distinguishing between FGM and FGCS, as indeed one audience member of Q&A put to Germaine Greer. The questioner suggested that girls upon whom FGM is performed are forced to undergo the procedure against their will. But in Australian FGM legislation, as feminist academic Nikki Sullivan points out, consent is immaterial.

It does not distinguish between the genital modification of children and consenting adults, stating that “consent to FGM is not a defence to a charge under the relevant sections of the Acts”.

Why then, even if women are consenting to it, is FGCS legally defensible?

Health practitioners say it may be therapeutic. If a patient can demonstrate that she’s suffering from her condition (for example, if the size of her labia are causing her acute embarrassment or physical discomfort), then surgical removal is a therapeutic option.

There seems to be a sly double standard at work here.

It seems easy and natural for us to assume that FGM is a grave cultural wrong and should be stopped, but we have a harder time thinking of FGCS as a “cultural” issue, preferring instead to label it a medical one.

If, as the literature tells us, the majority of women seeking labiaplasty are mainly worried about the appearance of their genitals, we might conclude that cultural standards of appropriate femininity are increasing pressure on women to conform, especially now that the public gaze appears to have reached the genital area – it’s not just confined to small breasts, flabby stomachs and ageing faces anymore.

But when it comes to what we understand as “culture”, the ethics get muddy.

Is “culture” only culture when it applies to other people? This is at the heart of feminist thinking around the comparisons between FGM and FGCS.

A look back at our colonial history muddies the ethical waters of FGM/FGCS even more.

When 19th century white colonists encountered the Khoi women of the Cape of Good Hope, they were horrified and titillated by the size of their genitals.

Anthropological writers such as Captain Cook, Ten Rhyne, Blumenbach and Cuvier publicised their observations of these women’s labia minora and came up with the moniker of the “Hottentot Apron” to describe the condition of “labial hypertrophy” that they believed the women’s bodies displayed.

One particular Khoi woman by the name of Saartjie Baartman – labelled by Europeans as the “Hottentot Venus” – came to be widely known in Europe as the definitive model of black female sexuality. She was literally put on display (in the tradition of human zoos) for the European public, but also for men of science who were given the opportunity to “examine” her, especially her intimate parts, until her death in 1815.

This encounter with European anatomists would produce Baartman’s body as one of the most visible and enduring images of black femininity in the history of white, colonial ethnography.

The point is that ideas about genital abnormality always exist in a social context. What we might understand today to be a white, Western practice – the surgical removal of the labia for cosmetic reasons – is historically embedded in 19th century race science.

In other words, the diagnosis of labial hypertrophy is a slippery term that was once used primarily to promote the idea of a fundamental difference between blacks and whites in the service of racist notions of white superiority (all white women were deemed to have small labia minora, which we know now to be factually incorrect).

In the discussion around the differences and similarities between FGM and FGCS, we would do well to remember Saartjie Baartman, and to give pause to the way in which our own cultural assumptions may be influencing how we value different forms of body modification.